一期后路清除病灶、异体植骨融合内固定治疗腰骶椎结核的临床观察

The treatment of lumbar sacral vertebral tuberculosis was treated with a posterior approach to remove the lesion and allograft fusion

目的观察手术治疗老年腰骶椎结核的效果。方法选择2015年6月-2016年9月行手术治疗的老年腰骶椎结核患者20例,均采用一期经后路清除结核病灶、异体植骨融合、椎弓根钉棒系统内固定术治疗,观察其治疗效果。结果手术用时90~220 min,中位数160 min;出血量300~800 ml,中位数400 ml,切口全部一期愈合。术后随访12~26个月,中位数18个月,所有患者结核均控制良好,后凸畸形得到有效矫正,椎间植骨全部骨性融合,神经功能较术前有明显恢复(P<0.05)。结论一期后路病灶清除、异体植骨融合内固定治疗老年腰骶椎结核手术操作相对简便、创伤小,能有效重建脊柱稳定性,纠正和预防后凸畸形,无需二期手术,临床治疗效果满意。

Objective To observe the effect of surgical treatment of lumbosacral tuberculosis in the elderly. Methods20 cases of elderly patients with lumbosacral tuberculosis requiring surgical treatment were selected from June 2015 to September 2016. The first stage was used to remove the tuberculosis focal point,allograft fusion and fixation of nail rod system. Postoperative follow-up review was performed,the treatment effect was observed. Results The operation time was 90 ~ 220 min,with an average of 160 min. The amount of blood was 300 ~ 800 ml. Mean 400 ml,all incisions were healed. Postoperative follow-up was 12 ~ 26 months,with an average of 18 months. The hematological indicators of all patients showed that the tuberculosis was well controlled,the posterior convex malformation was effectively corrected,and all bone grafts in the intervertebral implant were completely fused,and there was a significant recovery before the function of the divine function（P〈0. 05）. Conclusion One stage posterior lesions cleared,allograft bone graft fusion and internal fixation treatment of senile lumbar sacral vertebra and spinal operation is relatively simple,small trauma,can effective reconstruction of spinal stability,protrusion deformity after corrective and preventive,effect is satisfactory.